Abstract
Objectives
This project aims to explore reasons for variable uptake of the Bay Navigator Pathways among General Practitioners in the Western Bay of Plenty Primary Healthcare Organisation (PHO). The project aims were to identify barriers and facilitators in the use of the Bay Navigator Pathways and develop recommendations for improving the utility of Bay Navigator Pathways by general practitioner users.
Study design
General practitioners (GP) were purposively sampled to include specific pre-determined criteria in order to cover a range of GP characteristics. GPs were interviewed using semi-structured qualitative interviews. Data saturation was reached after fifteen interviews. Interviews were transcribed in full. A thematic analysis was undertaken, informed by the Diffusion of Innovation Framework (an analytic model used in quality improvement research).
Results
An understanding of the barriers and facilitators that influenced the acceptance and use of the local general practice population was achieved. Unmet and unrealistic expectations from the onset of the Bay Navigator Initiative were identified. Low centrality of the Bay Navigator Pathways hindered the use and acceptance of the Bay Navigator Pathways. Initial and ongoing issues with technology and incompatibility of the different practice management systems were identified as a universal issue between interviewees. However, the trial period for the Bay Navigator Pathways still has a window for opportunity to improve acceptance and use. Lessons learned through this research should be taken into account to assist ongoing development of the Bay Navigator Pathways.
Conclusion
The research showed that general practitioners must exercise an expansive clinical and patient management skill set within the current health system. Adequate support through ongoing education and development of skill should be high on the agenda for Health Workforce New Zealand.
General practitioners should have the ability to triage, investigate, treat and support patients in an effective, cost-effective way. Patients that need secondary care input should have a smooth transit from primary into secondary and again smooth transit of care back into primary with clear treatment plans and goals acceptable to the patient and their whanau. The New Zealand health system should be an entity that people can trust and rely on in time of need.
Innovations like the Bay Navigator Pathways can be valuable tools to achieve these goals. There are no infallible rules when developing and implementing health care initiatives. Knowledge about the specific locally appreciated barriers and facilitators can inform healthcare developments in future.